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PA abdomen

Chief complaints abdominal pain, indigestion, vomiting, diarrhea, constipation, flatus, melena, fecal incontinence, jaundice, dysuria, hematuria, radiating pain, etc
PMH allergies, substances, preventatives, trauma, illness/surgeries, mental health, environmental exposures
personal/social history ADLs, nutrition (increased fat, acid, gas formation, intolerances, cultural/ethnic foods, wt loss or gain), stresses, coping, values/beliefs, relationships, economics
family hx gallbladder disease, kidney disease, malabsorption syndrome, hirschsprung disease, colon cancer
hirschsprung disease part of the colon is missing nerves and cannot contract, so obstruction occurs
alimentary tract 27 foot tube from mouth to anus
esophagus 10 inch collapsible tube, connect pharynx to stomach, in chest and abdominal cavities
stomach in left upper quadrant below diaphragm. 3 sections are fundus, body, and pylorus. Secrete HCl/enzymes to break down fats/proteins
small intestine connects stomach to large intestine, 3 sections are duodenum, jejunum, and ileum. complete digestion, nutrients absorbed throguh wall into body
large intestine (colon) connects small intestine to anus. 4 sections are cecum, ascending colon, transverse colon, descending colon. Functions include water absorption, lubrication, and putrefication
functions of alimentary tract ingest and digest food, absorb nutrients/electrolytes/water, excretes watses, peristalsis
peristalsis moves food along tract
liver (location) four lobes in right upper quadrant
liver (major functions) metabolizes fats and carbs, converts amino acids to glucose, synthesizes fats from carbs/proteins, stores vitamins and iron, detoxifies harmful substances, produces antibodies/blood coagulants, synthesizes bile, converts waste from fat to water soluble
gallbladder pear shaped organ recessed in liver, concentrate and store bile
pancreas • Located behind/beneath stomach • Function: produces digestive juices and insulin/glucagon
spleen positioned in LUQ below kidney; 2 tissues- white pulp (filters blood, produces wbcs), red pulp (stores/releases blood)
kidneys retroperitoneal, connected to bladder via ureters, rid body of wastes, produces renin, erythropoetin, vitamin D, synthesizes prostaglandins
order of abdominal exam inspect, auscultate, percuss, palpate
Four Quadrants of abdomen right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant
Inspection of abdomen surface characteristics, contour (flat, round, scaphoid, protuberant), location of umbilicus, symmetry, surface motion (pulsations), distention
abdominal aortic aneurysm bruit, wide aorta, decreased femoral pulses, 50% asymptomatic
9 causes of distention (9 F's) fat, fluid, feces, fetus, flatus, fibroid, full bladder, false pregnancy, fatal tumor
causes of increased bowel sounds gastroenteritis, early obstruction, hunger
borborygmi loud gurgling
high pitched tinkling upon auscultation early obstruction
decreased bowel sounds late obstruction, peritonitis, paralytic ileus
absence of bowel sounds must listen for 2-5 minutes
bruit sounds like murmur, turbulent flow (use bell)
friction rub check over spleen and liver, high pitched sound associated with respiration (use diaphragm)
percussion of liver percuss at R MCL, go from tympany or resonance to dullness.
average span of liver 6-12 cm
when is liver displaced downward? lung disease
when is liver displaced upward? pregnancy
percussion of spleen o Percuss along left anterior axillary line- should be no dullness o May be area of dullness between 6th and 11th rib just posterior to left midaxillary line (not >7cm)
percussion of kidneys CVA tenderness (kidney punch)
light palpation 1 hand, <1 cm depth
deep palpation 2 hands, dominant hand down
palpation of liver normal liver edge should be soft to moderately firm, smooth, distinct margins, non tender
palpation of spleen not normally felt, enlarges toward midline
palpation of kidneys press both hands together
palpation of abdominal aorta palpate deeply, just above umbilicus, normal aortic pulse may be felt, but should be anterior in direction (lateral pulsation suggests abdominal aortic aneurysm)
signs of advanced liver disease hyperbilirubinemia (icterus, jaundice, bilirubinuria), ascites, increased estrogen levels, lower extremity edema, varices
icterus yellowing of the eyes
jaundice yellowing of the skin
bilirubinuria bilirubin in urine, dark color
detection of ascites percuss for dullness/shifting of dullness
signs of increased estrogen levels gynecomastia, spider angiomata, testicular atrophy
rebound tenderness pain or tenderness upon removing pressure, not placing pressure
appendicitis inflammation/rupture of appendix
cholecystitis inflammation of gallbladder
pancreatitis inflammation of pancreas
diverticulitis inflammation of diverticula
volvulus twisting of intestines
salpingitis inflammation of fallopian tube
PID pelvic inflammatory disease
renal calculi kidney stones
peritonitis inflammation of peritoneum, most commonly due to ruptured appendix
misc. causes of abdominal pain perforated ulcer, intestinal obstruction, ectopic pregnancy, ruptured ovarian cyst, splenic rupture
Created by: alexadianna